Preconception

Three questions you need to ask your OB/GYN

By Gina Roberts-Grey

While the cervical cancer vaccine promises to have a tremendous impact on women's health in the future, it leaves women wondering what this new development means for them and what is available now to safeguard them from the disease. As part of January’s distinction as cervical health awareness month, women need to understand the latest technology in cervical cancer prevention and screening.

If I receive the cervical cancer vaccine, do I still need to get an annual Pap test?

“YES!” stresses Obstetrician and Gynecologist, Dr. Joshua Holden, M.D. of Columbia University Medical Center in New York, New York, “The Human Papillomavirus (HPV) vaccine is primarily only for females who have never been sexually active.”

While the HPV vaccine is a remarkable advance in medicine, it should not be considered as a replacement to a woman's annual pap test or as an option to completely prevent cervical cancer. There are nearly forty known types of HPV and the vaccine only protects against four of the most dangerous types of HPV. “Two of the forms of HPV that the vaccine protects against are responsible for only approximately 70 to 80 percent of all cervical cancers,” explains Dr. Holden, “ and two types that cause 90 percent of all genital warts,”

Because there are several types of HPV not prevented with the vaccine that can infect the genital tract, a Pap test remains the only way to detect whether cervical cancer is present. “It will take years to collect data on how effective the vaccine is long term,” cautions Dr. Holden stressing that even if the pap test is negative for any evidence of HPV, doesn’t mean you’re not exposed.

Regardless of whether you’ve received the HPV vaccine or not, health care experts also stress that routine pap tests are recommended in order to detect pre-cancerous or cancerous cervical cells.

Does it matter what kind of Pap test I get?

There are two types of pap tests currently available to women in the United States. Used for decades, traditional tests require a physician to collect cervical cells, smear them on a slide, affix them with a preservative bonding agent and then send the sample to a lab for processing. Introduced in 1996, ‘liquid’ pap tests use a collection device that allows the physician to place the entire sample into a vial that has been pre-packed with a liquid is preservative fluid. When the doctors collect cell samples from the woman using a liquid test, the cells are not smeared onto a slide and they are immediately fixed into the liquid filled vial.

Christie Bianchi, L.P.N., R.N. of Arlington, Massachusetts says, “One notable difference is liquid tests use nearly all of the cells collected whereas traditional smear tests use only approximately 20% of cells. The increased cell collection is one of the critical factors, along with the preservation of the cells, to evaluate size, shape, and features.”

“Many women do not realize they can ask their health care provider what type of test they are using, or request a test to ensure they receive the best test for them,” adds Bianchi.

In addition to converting to liquid pap tests, a number of hospitals and laboratories nationwide are implementing the first fully integrated, interactive computer system called the ThinPrep Imaging System to assist technicians and improve diagnostic accuracy of cervical cells. Many doctors and laboratories claim this system provides results that are more accurate within a faster turn-around time. “Early detection is the key to preventing cervical cancer because it can aid in the earlier detection of pre-cancerous changes,” adds Bianchi. Labeled by the FDA as “significantly more effective” than the conventional pap smear for the detection of low-grade and more severe lesions, this new imaging procedure is thought to increase the opportunity to detect and treat cervical abnormalities earlier.

A new e2 collector developed by CytoCore also hopes to improve the accuracy of future pap tests by consistently retrieving a more thorough collection of cells for the pap test slide exam.  Available in the spring of 2007, this device when available hopes to will cut the number of false negative test results in half. Also, CytoCore’s InPath system, which is schedule to hit the market mid 2008, plans to increase pap test accuracy up to 85-90 percent from the current 50 to 70 percent rate.

“Our Drug Delivery Device, which will be available within the next two years, will give the physician for the first time the ability to apply a therapeutic compound to the cervix to treat early to middle level lesions before they get bad or need surgery,” says Gene Martineau, a CytoCore spokesman.

“You are your own health advocate and it is important to know have knowledge of the latest advancements in prevention, testing and detection and discuss what options are best for you with your health care provider,” says Bianchi.

How does family history factor into cervical cancer?

Unlike other female cancers, cervical cancer is not thought to be specifically an inherited cancer, but health experts are continuing to learn all of the factors that affect a woman’s chance of developing cervical cancer after being exposed to HPV. 

“There is overwhelming evidence that an HPV infection is required in order to develop cervical cancer,” says w omen’s health specialist, Dr. Christine Vergara, M.D. of The Gynecology Center at Mercy Medical Center, in Baltimore, Maryland “However, since many people are exposed to HPV but not all of them develop cervical cancer, there are a lot of other factors (smoking, sexual history, immune status, diet, etc) that seem to have a relationship with a woman’s chances of developing cervical cancer.   .

“The most important piece of armor in to protecting cervical health is routinely seeing a gynecologist for recommended pap tests,” says Dr. Vergara, who d irects the adolescent gynecology program, focusing on comprehensive well-women care and surgical gynecology , , “ The vaccine does not treat existing cervical cancers, and a pap test allows physicians to detect abnormalities in cervical cells and pre-cancerous lesions at an early, curable stage.”